NPIMap

Individual provider Active NPI

Keith F. Roberts Jr., MD

  • Surgery Physician
  • Demopolis, AL
National Provider Identifier
1245320340
Registry record updated Aug 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
25746 Issued in AL
Practice address
105 US Highway 80 E
Suite 215
Demopolis, AL 36732-3605
Phone
(334) 287-2840
Fax
(334) 287-2846
NPI assigned
Oct 13, 2006
Last updated
Aug 27, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 25746 AL Primary

Addresses

Primary practice location

105 US Highway 80 E
Suite 215
Demopolis, AL 36732-3605

Mailing address

PO Box 890
Demopolis, AL 36732-0890
Phone (334) 287-2840

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060228000331 AL Practitioner - General PracticePractitioner - General SurgeryPractitioner - Emergency Medicine 3476569419 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General PracticeAlso: Emergency Medicine
Education
Meharry Medical College School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tombigbee Healthcare AuthorityGroup PAC ID 6709873235, 41 clinicians

Practice addresses (Care Compare)

105 US Hwy 80 E
Demopolis, AL 36732-3605
Phone (334) 289-4000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue70

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Tombigbee Healthcare Authority CurrentSince Sep 16, 2019 Accepting new patients
Tombigbee Healthcare Authority Current Accepting new patients
Carraway Emergency Physicians, LLC Past Accepting new patients
The Sylacauga Health Care Authority Past Accepting new patients

Locations

105 US Highway 80 E
Demopolis, AL 36732
Phone (334) 287-2669

105 US Highway 80 E
Ste 215
Demopolis, AL 36732
Phone (334) 287-2825

105 US Highway 80 E
Ste 230
Demopolis, AL 36732
Phone (334) 287-2840

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377561600000",
    "number": "1245320340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 890",
            "city": "DEMOPOLIS",
            "state": "AL",
            "postal_code": "367320890",
            "telephone_number": "334-287-2840",
            "fax_number": "334-287-2846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 US HIGHWAY 80 E",
            "address_2": "SUITE 215",
            "city": "DEMOPOLIS",
            "state": "AL",
            "postal_code": "367323605",
            "telephone_number": "334-287-2840",
            "fax_number": "334-287-2846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "KEITH",
        "middle_name": "F.",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2013-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AL",
            "license": "25746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Demopolis, AL

Sources for this page

Verify at the official NPI Registry.